Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

Background: The aim of the study is to compare the efficacy of autologous incus versus allogenic titanium prosthesis in terms of anatomical results, hearing gain after surgery, operative course and complications.Methods: This is a prospective interventional study of 20 patients out of which 10 underwent autologus incus and 10 underwent titanium prosthesis ossiculoplasties performed between April 2018 To April 2019 in Government Kilpauk medical college and hospital, Chennai after ethical clearance. The postoperative improvement of mean air-bone gap and air conduction over same frequencies between the two groups were studied. A improvement in pure tone average more than 10 dB was considered successful.Results: In current study, 10 patients underwent ossiculoplasties using titanium ossicular replacement prosthesis and 10 patients underwent ossiculoplasties using autologous incus. 5 of the patients in each group underwent canal wall up and 5 underwent canal wall down procedure. The average ABG closure was 9.30 dB in incus group and 15.22 dB in titanium group.Conclusions: Titanium ossicular prosthesis ossiculoplasties provide a significant hearing gain and are advantageous because of the easy insertion with pre-sculpted structure yet the cost is a concern. Better results were noted in canal wall up procedures more than canal wall down procedures.

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Autologous total ossicular replacement prosthesis

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002679 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1050-1055 ◽

Cited By ~ 5

Author(s):

M Malhotra ◽

S Varshney ◽

R Malhotra

Keyword(s):

Pure Tone ◽

Chronic Otitis Media ◽

Canal Wall ◽

Hearing Improvement ◽

Hearing Results ◽

Replacement Technique ◽

Ossicular Replacement ◽

Canal Wall Down ◽

Replacement Prosthesis ◽

Air Conduction

AbstractObjective:To develop an autologous total ossicular replacement prosthesis with sustainable hearing results.Methods:The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air–bone gap measured at 0.5, 1, 2 and 3 kHz.Results:Successful rehabilitation of pure tone average to 30 dB or less was achieved in 75 per cent of patients, and air–bone gap to 20 dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air–bone gap was 23.9 ± 8.5 dB (p < 0.001). Mean improvements in air–bone gap were significantly greater (p < 0.05) in the tympanoplasty only group (27.3 ± 6.6 dB) and the intact canal wall tympanoplasty group (25.9 ± 6.3 dB) than in the canal wall down tympanoplasty group (16.3 ± 8.9 dB).Conclusion:This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

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A comparative study of hearing outcomes in canal wall up versus canal wall down mastoidectomy in our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190491 ◽

2019 ◽

Vol 5 (2) ◽

pp. 472

Author(s):

Poornima S. Bhat ◽

G. Gandhi ◽

K. Pradheep

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Pure Tone Audiometry ◽

Canal Wall ◽

Hearing Gain ◽

Hearing Outcome ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Conductive Hearing ◽

Canal Wall Up

Background: COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Ossicular reconstruction is a surgical procedure which intends to improve the quality of hearing and life in such patients. Comparison of the outcomes will help to determine the merits or demerits of a particular procedure.Methods: The study was conducted in the Department of ENT, VIMS, Bellary during the period from December 2010 to May 2012. All the patients with CSOM with ossicular erosion suggested by conductive hearing loss more than 40dB were included in the study. A detailed history taking, thorough clinical examination was done for these patients. Before and after the procedure pure tone audiometry was done to assess the hearing outcome. Post operatively PTA was done in 6th week, 3rd month, 6th month follow up. Hearing improvement was analysed according to the type of procedure. The data collected was tabulated and subjected to statistical analysis. Results: This study compared the outcomes of hearing gain in canal wall up versus canal wall down mastoidectomy surgeries. Hearing gain was better in canal wall up mastoidectomy (18.36 dB) than canal wall down mastoidectomy surgeries.Conclusions: Hearing outcome was better in intact canal wall mastoidectomy than canal wall down mastoidectomy in our study.

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A multivariate analysis of the factors predicting hearing outcome after surgery for cholesteatoma in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002179 ◽

2006 ◽

Vol 120 (11) ◽

pp. 908-913 ◽

Cited By ~ 17

Author(s):

N K Chadha ◽

A Jardine ◽

D Owens ◽

S Gillett ◽

P J Robinson ◽

...

Keyword(s):

Canal Wall ◽

Hearing Outcome ◽

Cohort Differences ◽

Canal Wall Down ◽

Hearing Outcomes ◽

Mastoid Surgery ◽

Disease Free ◽

Canal Wall Up ◽

Air Conduction

Objective: To explore factors influencing hearing outcomes in children treated by canal wall up (CWU) and canal wall down (CWD) mastoid surgery.Methods: Retrospective cohort study including three units in Bristol and Bath, UK. Ninety consecutive children underwent cholesteatoma mastoid surgery, with the first procedure between 1998 and 2001; minimum follow up was three disease-free years.Results: The CWU and CWD cohorts significantly differed in pre-operative stage and hearing. After disease eradication, air conduction (AC) thresholds changed by +4.0 dB (95 per cent confidence intervals (95%CI) −2.0, 10.1) in the CWD group and −5.3 dB (95%CI −9.3, 1.3) in the CWU group (p=0.029). Using multiple linear regression to account for cohort differences, AC thresholds were increased by: pre-operative AC threshold (p<0.0001), initial ossicular stage (p=0.013), and CWD-surgery (p=0.005).Conclusion: Disease-free hearing was better with CWU-surgery, less initial ossicular damage, and better pre-operative hearing. Worse initial disease increased the likelihood of CWD surgery. Wider use of ossiculoplasty in the CWU cohort (51 per cent vs 5 per cent) may partially explain the superior results.

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Quality of Life Assessment after Canal Wall Down Mastoidectomy: Our Experiences in Shaheed Ziaur Rahman Medical College Hospital, Bogura

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i1.53205 ◽

2021 ◽

Vol 27 (1) ◽

pp. 52-58

Author(s):

Md Khorsed Alam ◽

Md Saiduzzaman ◽

Md Asadur Rahman ◽

Syed Sanaul Islam ◽

Mohammad Anisur Rahman ◽

...

Keyword(s):

Quality Of Life ◽

P Value ◽

Canal Wall ◽

College Hospital ◽

Medical College ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Subjective Outcomes ◽

Air Conduction

Objective: To determine subjective outcomes after cholesteatoma surgery. Design: Cross sectional observational study Methods: Study place: Shaheed Ziaur Rahman Medical college Hospital (SZMCH), Bogura, Bangladesh Study population: Chronic otitis media (COM) with extensive cholesteatoma. Interventions: Canal wall down mastoidectomy for cholesteatoma. Main Outcome Measures: In this study, the Chronic Ear Survey (CES) was provided to all patients preoperatively and one year after surgery. The preoperative and postoperative score differences were analyzed. We also assessed correlations between chronic ear survey scores and air conduction threshold. Results: Seventy six patients were enrolled in our study & marked improvements were found in total CES score & all subscale scores postoperatively (P value: 0.00). The total CES score and symptom subscale scores were observed greater improvement (P value: 0.00).Significant negative linear correlations were observed among total CES scores, symptom subscale scores and air conduction thresholds (P<.05). Conclusion: The present study suggests that canal wall down mastoidectomy (CWDM) provides a significant improvement in the post-operative Quality of life (QoL) &b there is a significant association between subjective outcomes &the objective audiometric results. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 52-58

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Outcomes of type III tympanoplasty: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200139 ◽

2020 ◽

Vol 6 (2) ◽

pp. 287

Author(s):

Ravishankar C. ◽

Ramya Bandadka

Keyword(s):

Middle Ear ◽

Chart Review ◽

Retrospective Chart Review ◽

Canal Wall ◽

Type Iii ◽

Hearing Gain ◽

Middle Ear Prosthesis ◽

Canal Wall Down ◽

Middle Ear Cleft ◽

Canal Wall Up

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.Methods: A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared. Results: 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.Conclusions: The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.

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A study on the effect of grommet as partial ossicular replacement prosthesis in type III tympanoplasty in patients with chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200048 ◽

2020 ◽

Vol 6 (2) ◽

pp. 263

Author(s):

M. D. Prakash ◽

Lyra Joy ◽

Priya Jose

Keyword(s):

Otitis Media ◽

Ossicular Chain ◽

Canal Wall ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Type Iii ◽

Ossicular Replacement ◽

Canal Wall Down ◽

Replacement Prosthesis ◽

Canal Wall Up

Background: Chronic otitis media (COM) with or without cholesteatoma causes ossicular erosion/ destruction which leads to conductive hearing loss. Ossiculoplasty is to reconstruct the hearing mechanism in ear after eliminating the disease from the middle ear. In our study we used ventilation tubes or grommet as partial ossicular replacement prosthesis (PORP) for the reconstruction of the ossicular chain especially when the stapes is mobile. The objective of the study is to assess the degree of hearing improvement by using grommet as PORP in type III tympanoplasty.Methods: It was an observational study from July 2018 to July 2019. 20 patients with COM undergoing canal wall up or canal wall down mastoidectomy with intraoperative ossicular chain erosion with intact stapes suprastructure were included in this study. Post-operative hearing gain and graft uptake was assessed at 3rd month. Results: Among these 20 patients 15 underwent canal wall up mastoidectomy with type III tympanoplasty and 5 underwent canal wall down procedure with type III tympanoplasty. Incus was eroded in 17 cases, malleus in 2 cases and malleus with incus eroded in 1 case. The pre op average airborne gap was 38 dB and mean improvement of 12 dB was observed at third month.Conclusions: Grommet tube used as PORP is an effective alternative in the reconstruction of ossicular chain with good hearing improvement.

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Correlation between functional outcome and the SAMEO-ATO framework

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07000-3 ◽

2021 ◽

Author(s):

Vito Pontillo ◽

Marialessia Damiani ◽

Giusi Graziano ◽

Nicola Quaranta

Keyword(s):

Functional Outcome ◽

Middle Ear ◽

Petrous Bone ◽

Canal Wall ◽

Hearing Results ◽

Tertiary Referral Center ◽

Ossicular Reconstruction ◽

Canal Wall Down ◽

Mastoid Surgery ◽

Canal Wall Up

Abstract Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

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Hearing Status After Ossiculoplasty in Open Cavity Mastoidectomy

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v23i2.45167 ◽

2020 ◽

Vol 23 (2) ◽

pp. 195-198

Author(s):

Md Zakaria Sarker ◽

DC Talukder ◽

Khabir Uddin Patuary ◽

Md Rafiqul Islam ◽

Saif Rahman Khan ◽

...

Keyword(s):

Hearing Loss ◽

Ossicular Chain ◽

Ear Reconstruction ◽

Canal Wall ◽

Prospective Longitudinal Study ◽

Hearing Gain ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Middle Ear Reconstruction ◽

Prospective Longitudinal

To evaluate the hearing outcome in canal wall down mastoidectomy with middle ear reconstruction, prospective longitudinal study was done at National Institute of ENT, Dhaka from March 2015 to September 2016. Total 22 patients were included in the study undergoing canal wall down mastoidectomy with 6 months postoperative followup. Hearing outcomes were observed and compared with the preoperative hearing tests. Among the 22 patients 9 (39.1% of subjects) patients had hearing gain, 12 (52.2%) had hearing loss and 1 (4.3%) had no change in hearing postoperatively.Although disease clearance is the main objective in canal wall down mastoidectomy, hearing gain can be achieved if combined with ossiculoplasty and tympanoplasty. The hearing gain or loss depends upon the extension of disease and status of the ossicular chain. Most patients usually experience hearing loss more than the preoperative period due to removal of ossicle or ossicles for the sake of disease clearance. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 195-198

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